A Legacy of Scientific Racism: William Osler's "An Alabama Student".

William Osler's essay "An Alabama Student" made John Young Bassett (1804-1851) a widely admired avatar of idealism in medicine. However, Bassett fiercely attacked the idea that all humans are members of the same species (known as monogenesis) and asserted that Black inferiority was a justification for slavery. Antebellum physician-anthropologists bequeathed a legacy of scientific racism that in subtler forms still runs deep in American society, including in the field of medicine.

Ending Racial Bias in American Medicine: A Call for Help from the AMA, NMA, AAMC, and the Rest of Us.

Bias based on skin color, religion, immigrant status, gender, and ethnicity are deeply rooted in American culture and have existed within the infrastructure of American medicine from the beginning. Now, medical educators are struggling to find curriculum and experiences that effectively address explicit and implicit bias among our increasingly diverse group of students, house staff, and practitioners. The leadership, experience, and lessons learned needed to scrub present medical school curricula of racial bias, to develop an antiracist curriculum, and to test its effectiveness already lies with the American Medical Association (AMA), the Association of American Medical Colleges (AAMC), and the National Medical Association (NMA). We call on these organizations to jointly convene a consortium of medical educators, social scientists, curricular specialists, and others to chart a way forward to assist medical schools and professional organizations in developing evaluable curricular materials and experiences to eliminate bias in health care.

Marijuana's Effects on Brain Structure and Function: What Do We Know and What Should We Do? A Brief Review and Commentary.

The recent US Food and Drug Administration approval of the marijuana constituent cannabidiol as safe and effective for treatment of 2 rare forms of epilepsy has raised hopes that others of the 500 chemicals in marijuana will be found to be therapeutic. However, the long-term consequences of street marijuana use are unclear, and recent studies raise red flags about its effects. Changes in brain maturation and intellectual function, including decreases in intelligence quotient, have been noted in chronic users and appear permanent in early users in most but not all studies. These studies suggest that at a minimum, regular marijuana use should be discouraged in individuals under the age of 21.

Backstories on the US Opioid Epidemic. Good Intentions Gone Bad, an Industry Gone Rogue, and Watch Dogs Gone to Sleep.

Epidemics of opioid use are old news in the United States, but an epidemic that kills over 200,000 Americans is not. A multiplicity of intertwined factors have brought us to this place. From 30,000 feet, it is the story of good intentions gone bad, a drug industry gone rogue, and government watch dog agencies gone to sleep. At ground level, it is the story of physicians unfamiliar with addictive drugs and drug addiction, new long-acting opioids deceptively marketed, cheap black tar heroin, encouragement to use opioids for chronic noncancer pain by professional organizations with conflicts of interest and without science, a culture intolerant to pain and tolerant to drug use, and the greedy response of the pharmaceutical industry and drug cartels to an expanding market opportunity. These factors are among those that have joined to form a tsunami of addiction and deaths that keeps on coming. A better understanding of them could speed the end of the present cycle of opioid abuse, perhaps prevent others, and inform future decisions about pain management.

The Underappreciated Doctors of The American Civil Rights Movement. Part I: Theodore Roosevelt Mason Howard, MD.

During the fight to end segregation in the United States, most of the 25 or so black physicians who had not already left Mississippi took risks to become active in civil rights locally and nationally. One of the first was T.R.M. Howard, MD, whose life story is both an encouragement and warning for today's physicians. Howard, the protégé of a white Adventist physician, became active in civil rights during medical school. While serving as chief surgeon of the all-black hospital in Mississippi, he formed his own civil rights organization in 1951 and worked to solve the shootings of 2 of its members, George Lee and Gus Courts, and the murder of Emmett Till in 1955. His reports of these events and collaborations with other civil rights icons helped trigger the modern civil rights movement. At the same time, he became a nationally known proponent of abortion rights and then fled to Chicago in 1956, after arming his Delta mansion with long guns and a Thompson machine gun. Howard will be remembered for many things, including his activism for the social determinants of health as president of the National Medical Association.

Novel Findings in HIV, Immune Reconstitution Disease and Strongyloides stercoralis Infection.

We report the successful treatment of an HIV-infected patient with progressive strongyloidiasis as a component of immune reconstitution disease and a review of the literature on this topic. In our experience, pre- and post-antiretroviral therapy intestinal biopsies support a novel mechanism of immune reconstitution disease to Strongyloides stercoralis. We conclude that extended, dual antihelminthic therapy and temporary discontinuation of antiretroviral therapy may be effective in similar patients.

Food Allergy: What We Know Now.

Food allergy is an adverse immune reaction that occurs reproducibly on exposure to a given food. Prevalence rates of food allergy continue to increase worldwide, sparking continual research efforts in finding a suitable and safe cure. Food avoidance, the current standard of care, can be difficult to achieve. This review aims to provide a broad overview of immunoglobulin E-mediated food allergy, highlighting its epidemiology, masqueraders, immunopathophysiology, clinical presentation, diagnostic work-up and available preventative and treatment strategies. This review also discusses novel, investigative therapies that offer promising therapeutic options, yet require continued research efforts to determine safety effects. Inducing tolerance, whether by immunotherapy or by the administration of monoclonal antibodies, allows us to move toward a cure for food allergy, which could vastly change this field of allergic diseases in the coming decades.

Lessons Learned from Mississippi's Telehealth Approach to Health Disparities.

Many people see telemedicine as a solution to the nation's health disparities and in Mississippi as a solution to our last place in health. More than 13 years ago, the University of Mississippi Medical Center developed a successful TelEmergency program that saved rural Critical Access Hospitals and now provides telehealth services throughout the state. This occurred without acrimony because of partnerships that the University of Mississippi Medical Center developed with telecommunications companies, state government, health professions' licensure boards, and private donors. Today, the telemedicine market is exploding across the country with the entry of for-profit corporations into the medical market. These corporations often are more inclined to work with legislators rather than physicians, and some physician groups have attempted to limit their expansion. With the future of telemedicine now determined in part by the courts, rather than the providers, new pitfalls have arisen. The Mississippi experience may be helpful in navigating this new territory.

An Unwilling Partnership With the Great Society Part I: Head Start and the Beginning of Change in the White Medical Community.

By 1965, the policies and programs of Lyndon B. Johnson's Great Society brought optimism to black physicians and a new wave of resistance against black civil rights advocates in the American South. The largest of the first Head Start programs, Child Development Group of Mississippi (CDGM), had its roots in Freedom Summer 1964 and the Medical Committee for Human Rights. Like other proposed programs with strong medical components, CDGM was caught in a legislative Bermuda triangle created by the powerful Mississippi congressional delegation to maintain white supremacy and plantation economics. Physician-led investigations exposed the extraordinary level of poor health among Mississippi's black children, supported Head Start as a remedy, and awakened the white medical establishment to health disparities of the Jim Crow period. It was also the beginning of positive change in the previously silent white medical community in the South and their support of civil justice in health.

An Unwilling Partnership With the Great Society Part II: Physicians Discover Malnutrition, Hunger and the Politics of Hunger.

The civil rights and social legislation of the Great Society following the Civil Rights Act of 1964 was slow to provide relief for black in the South. Mississippi Senator James Eastland led an effort to defund Head Start, including his state's program, Child Development Group of Mississippi (CDGM), a program with a strong medical component. A senatorial committee, including Robert Kennedy, came to investigate CDGM in 1967. The unimaginable poverty, hunger, malnutrition and chronic disease found in black families was vehemently denied by Eastland. Visits of physician groups then corroborated the findings. The Mississippi delegation made sure that food relief never came and funding for CDGM ceased. Health services were lost to 6000 impoverished children. The epic television documentary, Hunger in America, soon premiered on network television. It triggered ongoing efforts to address health disparities, including implementation of the National Nutrition and Health Survey (NHANES). Similar physician leadership is needed to address the lasting health disparities in our country.